Long-term Predictors of Morbidity in Older Age

简介（由申请人提供）：在过去的三十年中，肥胖和2型糖尿病（糖尿病）的患病率呈流行病的比例增加。在了解其复杂原因和多种健康后果方面取得了稳步进展。然而，重要的科学，临床和实际问题仍然存在，等待进一步阐明，以对抗和扭转日益恶化的肥胖和糖尿病双重流行病。作为对PA-03-015 （R21新研究者“创新研究资助计划”）的回应，本提案指出了与肥胖和糖尿病相关的几个问题，芝加哥心脏协会（CHA）工业检测项目和西部电气（WE）公司的研究为以成本效益和创新的方式阐明这些问题提供了一个不寻常的独特机会。我们将广泛使用CHA[1967-73年基线时年龄在18-64岁的20,854名男性和16,049名女性]和We[1957-58年基线时年龄在40- 55岁的2,107名男性]的现有数据，包括四个综合结果来源：1)长期随访的死亡率数据；2) 1984 - 2000年19年间医疗保险索赔的发病率和其他数据；3)多重健康问卷（CHA）；4)通过每年8次基线后复查（WE）对肥胖进行重复测量，以达到以下具体目的：1)深入研究青壮年和中年时期肥胖与后期充血性心力衰竭死亡率和发病率的纵向关联，这些指标包括体重指数、体重增加、肩胛下和三头肌皮肤褶皱以及衍生体脂百分比；2)描述早期评估的肥胖与老年多重疾病的关系，多种严重程度的病理状况并存，这是老年人中非常常见但研究不足的现象；3)深入研究心率和心率变化与糖尿病发病率的关系，并根据基线时的肥胖状况进行分层。作为一个探索性的目标，我们将评估是否a)多吃水果和蔬菜，少吃糖；b)较高的乳制品和钙摄入量与较低的肥胖、较小的体重增加和较低的糖尿病发病率有关。拟议的工作有可能为与肥胖和糖尿病有关的几个未被充分探索的科学和实际问题提供基本的新知识，有助于肥胖症、糖尿病和其他慢性疾病的战略性初级预防，并通过“帮助个人获得对其健康做出明智决定所需的知识、动力和机会”，实现“2010年健康人”的目标。

DESCRIPTION (provided by applicant): In the past three decades, the prevalence of obesity and type 2 diabetes mellitus (diabetes) has been increasing in epidemic proportions. Steady progress has been made in understanding their complex causes and diverse health consequences. However, important scientific, clinical, and practical questions remain and await further elucidation to combat and reverse the worsening twin epidemics of obesity and diabetes. In response to PA-03-015 (R21 new investigator "Innovative Research Grant Program"), this proposal pinpoints several issues related to obesity and diabetes for which the Chicago Heart Association (CHA) Detection Project in Industry and the Western Electric (WE) Company studies offer an unusual and unique opportunity for elucidation in a cost-effective and innovative way. We will use extensive existing data from the CHA [20,854 men and 16,049 women aged 18-64 at baseline (1967-73)] and WE [2,107 men aged 40- 55 at baseline (1957-58)] that include four comprehensive sources of outcomes: 1) mortality data from long-term follow-up; 2) morbidity and other data from Medicare claims for 19 years from 1984 to 2000; 3) multiple health questionnaires (CHA); and 4) repeated measures of adiposity from 8 annual re-examinations after baseline (WE) to address the following Specific Aims: 1) to investigate in-depth the longitudinal associations of adiposity as assessed by several indices (body mass index, weight gain, subscapular and triceps skinfolds, and derived percent body fat) during young adulthood and middle age with mortality and morbidity from congestive heart failure later in life; 2) to delineate the relationships of adiposity assessed earlier in life with older-age multimorbidity, the coexistence of multiple pathological conditions of varying severity -- a very common but under-studied phenomenon among older adults; 3) to examine in-depth the associations of heart rate and changes in heart rate with incident diabetes, stratified by obesity status at baseline. As an exploratory aim, we will assess whether a) higher fruit and vegetable and lower sugar intake; and b) higher dairy and calcium intake are associated with lower adiposity, smaller weight gain, and lower incidence of diabetes. The proposed work has the potential to provide fundamental new knowledge on several under-explored scientific and practical issues related to obesity and diabetes, contributing to strategic primary prevention of obesity, diabetes, and other chronic conditions, and towards achievement of the goals of "Healthy People 2010" by "helping individuals gain the knowledge, motivation, and opportunities they need to make informed decisions about their health."